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Optimisation of disease assessments in juvenile idiopathic arthritis
A Consolaro1, B Schiappapietra, S Dalprà
1Istituto Giannina Gaslini and Università degli Studi di Genova, Genoa, Italy. alessandroconsolaro@ospedale-gaslini.ge.it.
Insights
Assessing juvenile idiopathic arthritis (JIA) requires updated measures beyond the American College of Rheumatology (ACR) criteria. New tools like JADAS and patient-reported outcomes are crucial for evaluating treatment effectiveness and achieving inactive disease in children.
Area of Science:
- Pediatric Rheumatology
- Clinical Trial Design
- Outcome Measurement
Background:
- Juvenile idiopathic arthritis (JIA) assessment relies on various clinical measures for trials and long-term surveys.
- The American College of Rheumatology (ACR) Pediatric 30 is a primary outcome, but more stringent criteria (ACR 50, 70, 90, 100) were used in 2000s studies.
- Therapeutic advances make inactive disease an achievable goal in JIA, necessitating updated outcome measures.
Purpose of the Study:
- To review current and evolving outcome measures for juvenile idiopathic arthritis (JIA).
- To discuss the incorporation of disease activity states and patient-reported outcomes in JIA assessment.
- To consider the role of advanced imaging in evaluating structural joint damage in JIA.
Main Methods:
- Review of existing clinical measures for JIA, including ACR response criteria.
- Discussion of the Juvenile Arthritis Disease Activity Score (JADAS) and its application.
- Emphasis on the integration of parent/child-reported outcomes and advanced imaging techniques (MRI, ultrasound).
Main Results:
- The ACR Pediatric 30 remains a standard, but more comprehensive measures are needed.
- JADAS and its defined cut-offs support a treat-to-target strategy for JIA.
- Parent/child-reported outcomes are increasingly important for reflecting patient perception of disease and treatment.
Conclusions:
- Future JIA clinical trials should incorporate disease activity states (inactive/low disease activity) and patient-reported outcomes.
- The JADAS facilitates a treat-to-target approach in JIA clinical practice and research.
- Advanced imaging may offer superior assessment of joint damage progression compared to conventional radiography.
Abstract:
A variety of clinical measures are available for assessment of disease status of children with juvenile idiopathic arthritis (JIA) in clinical trials, clinical care and long-term outcome surveys. The American College of Rheumatology (ACR) Pediatric 30 remains the preferred primary outcome measure for registrative trials, although in most therapeutic studies performed in the 2000s patients were also evaluated for more stringent levels of improvement, that is, applying the ACR Pediatric 50, 70, 90, and 100 response criteria. Because the recent therapeutic advances have made inactive disease an achievable goal in most patients, it has been suggested that endpoints for future clinical trials incorporate the evaluation of disease activity state, namely the assessment of inactive disease and low disease activity. The introduction of the Juvenile Arthritis Disease Activity Score (JADAS) and the establishment of its cut-offs for various disease activity states may foster the implementation of the treat-to-target strategy in both clinical trials and routine practice. In recent years, there has been an increased focus on the inclusion of patient and child perspectives in health outcome measures through the use of parent/child-reported outcomes. Integration of these measures in the clinical evaluation is considered important as they reflect the parent's and child's perception of the disease course and effectiveness of therapeutic interventions. Future studies will show whether the newer imaging modalities, namely magnetic resonance imaging and ultrasound, can replace conventional radiography for the assessment of structural joint damage and its progression.
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